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Case Reports in Neurological Medicine
Volume 2019, Article ID 9285460, 5 pages
https://doi.org/10.1155/2019/9285460
Case Report

A Case of Reverse Takotsubo Cardiomyopathy Incited by a Spinal Subdural Hematoma

1University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA
2Department of Neurosurgery, Allegheny General Hospital, 320 E North Ave., Pittsburgh, PA 15212, USA
3Florida Hospital, 601 E Rollins Street, Orlando, FL 32803, USA

Correspondence should be addressed to Kyle Sanchez; ude.fcu.sthgink@zehcnaselyk

Received 12 March 2019; Accepted 8 July 2019; Published 22 July 2019

Academic Editor: Shahid Nimjee

Copyright © 2019 Kyle Sanchez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Takotsubo cardiomyopathy is a rare syndrome of transient, reversible left ventricular systolic dysfunction. It mimics myocardial infarction clinically and includes elevated cardiac enzymes, but echocardiography reveals apical ballooning and basal hyperkinesis. Infrequently, midventricular or even reverse Takotsubo patterns have been described, involving ballooning of the basal heart without the characteristic ‘Takotsubo’ appearance. There are cases in the literature that support a connection between reverse Takotsubo cardiomyopathy (r-TTC) and neurological insults as inciting factors. We report a case of r-TTC in an otherwise healthy 23-year-old man presenting with back pain, urinary retention, bradycardia, and hypertension. Troponin levels and brain natriuretic peptide (BNP) were elevated, and echocardiogram revealed an ejection fraction (EF) of less than 20%. In addition, MRI demonstrated a spinal subdural hematoma from T1-S1 with no cord compression. Repeated echocardiogram demonstrated an EF of 20-25% with a reverse Takotsubo pattern of cardiomyopathy. With supportive care, his clinical picture improved with normalization of cardiac enzyme and BNP values. This case represents a r-TTC presenting as heart failure in a young, apparently healthy male likely incited by a spinal subdural hematoma. To our knowledge, it is the first of its kind reported.